Wisconsin private health insurers must cover copays for COVID-19 testing, office visits

OCI clarifies federal requirements

A COVID-19 testing tent set up in the parking lot of Ascension SE Wisconsin Hospital - Elmbrook Campus.
A COVID-19 testing tent.

Last updated on May 22nd, 2020 at 11:59 am

Wisconsin private health insurers must cover copays for COVID-19 testing and related doctor’s visits, state Insurance Commissioner Mark Afablee said Tuesday. 

The Wisconsin Office of the Commissioner of Insurance issued a notice to insurers this week to clarify federal requirements that all cost-sharing for office, urgent care and emergency department visits related to COVID-19 diagnostic testing must be covered by private health insurance.

The federal requirements – detailed in the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security (CARES) Act – apply to most health insurers, including plans that are fully insured or self-funded plans, non-federal, governmental plans and church plans, along with individual and group health insurance plans offered through and outside of the federal Marketplace. 

“We need folks to know that testing for COVID-19 is available and can be accessed without any out-of-pocket costs,” Afable said. “Under federal law, most insurers cannot require cost-sharing like co-pays for office, urgent care, or emergency department visits. If you have symptoms of COVID-19 or have been exposed to someone with the disease, get tested.”

The CARES Act also requires any COVID-19 vaccine to be covered at no cost to consumers.

Ascension Wisconsin, Froedtert & the Medical College of Wisconsin, Advocate Aurora Health and Milwaukee’s federally qualified health centers are offering testing at some of their locations, and community testing sites are also available in many cities, including two drive-thru/walk-up sites in Milwaukee.

Gov. Tony Evers announced Tuesday a plan to bolster statewide COVID-19 testing with $260 million in federal funding. The allocation includes $202 million to provide COVID-19 test collection kits to hospitals, clinics, nursing homes, local public health department at no cost. Another $45 million will go to local public health departments, occupational health providers, home health agencies and health systems to conduct testing in congregate, community and occupational settings.

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Lauren Anderson
Lauren Anderson covers health care, nonprofits, education and insurance for BizTimes. Lauren previously reported on education for the Waukesha Freeman. She graduated from the University of Wisconsin-Madison, where she studied journalism, history and African studies. In her free time, Lauren enjoys spending time with family and friends and seeing live music wherever she can.

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